Evaluating Rehabilitation Potential in Pain Patients

Abstract

A method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, by maximizing multidimensional rehabilitation outcomes by better identifying the specific needs of each patient; understanding the many obstacles to rehabilitation success falling into motivational, physical, and emotional categories; physical obstacles to rehabilitation including but not limited to incorrect diagnoses and deconditioning; emotional obstacles including fear avoidance, catastrophizing, generalized anxiety, depression, childhood adverse events, emotional awareness deficits; and motivational obstacles including factitious disorder, personality disorders, malingering and apathy. The resulting comprehensive pain rehabilitation program combines multiple treatment options. Medicinal treatments include anti-inflammatory medications; muscle relaxants; opioids and cannabinoids; injection therapies; neuropathic medications; and pain adjuvant medications. Mental health services include mindfulness, biofeedback, progressive relaxation, cognitive behavioral therapies, logotherapy, and trauma therapies. Physical rehabilitation services include physical or occupational therapy; chiropractic; massage therapy; acupuncture; osteopathy and personalized exercises.

1 . A method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, by maximizing multidimensional protocols for rehabilitation and pain resolution by better physiologically identifying the specific needs of each particular patient; understanding the many obstacles to rehabilitation which fall into motivational, physical, and emotional categories; physical obstacles to rehabilitation including but not limited to incorrect diagnoses, refractory pain, and deconditioning; emotional obstacles to rehabilitation including fear avoidance, catastrophizing, generalized anxiety, depression, childhood adverse events, emotional awareness deficits; and motivational obstacles to rehabilitation including factitious disorder, personality disorders, malingering and apathy; the method comprising the steps of:
 a. evaluating a referred patient complaining of chronic pain and determining whether prior traditional biomedical assessments are complete or incomplete;   b. finding the prior traditional biomedical evaluation incomplete due to missing tests that were not performed; completing the missing tests by performing the missing tests which are imaging tests, laboratory tests, and neurodiagnostic test;   c. reviewing the results of the missing tests and identifying a previously unidentified physical problem, providing the patient with traditional biomedical care including anesthetist injections or surgery, and obtaining ail of the results of the completed traditional biomedical care testing;   d. contemplating treatment for low back pain, options include provide epidural or medial branch anesthetist injections; placement of spinal cord stimulator; lumbar surgeries including one or more of foraminotomy, laminectomy, fusion without instrumentation, fusion with instrumentation and others;   e. evaluating the referred chronic pain patient test results and finding prior traditional biomedical work-up completed; determining the patient is a potential candidate for multidimensional pain rehabilitation program that integrates medicinal, psychological and physical rehabilitation; providing the patient with an evaluation according to the Biopsychosocial Model of Pain and obtaining the results of the testing after the testing is completed   f. reviewing the results of the initial Biopsychosocial equation and determining that the patient is not a good candidate for multidimensional pain rehabilitation; the patient will be referred for ongoing chronic pain management including one or more of opioid medication, intrathecal morphine, and intermittent injections therapy;   g. reviewing the results of the initial Biopsychosocial Pain Model and determining the patient is a potentially good candidate for multidimensional rehabilitation; the patient is referred for a detailed, neurophysiologically based, scientifically valid Rehabilitation Neurophysiologic Assessment supplemented by psychological testing which identifies the patients individual needs within a multidimensional pain rehabilitation optimizing the amounts and types of medications, physical rehabilitation options, and mental health therapy, which are provided to the patient; and   h. reviewing the results of the Rehabilitation Neurophysiologic Assessment and supplemental psychological testing, and determining the patient is a good rehabilitation candidate; using the test data results, the patient is put into a specifically designed program that meets the patient's specifically identified neurophysiological and psychological requirements with improved outcomes and reduced overall costs.   
     
     
         2 . The method of evaluating rehabilitation requirements for patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 1 , further comprising the steps of:
 a. reviewing the Rehabilitation Neurophysiologic Assessment and supplemental psychological testing results which determines the precise type of medication needs of the individual with treatment options for the patient being anti-inflammatory medications reducing inflammation related tenderness; muscle relaxants reducing muscle tensions; trigger point injection reducing focal muscle spasms; Joint injections treating joint tenderness; gain adjuvants that treat brain pain pathway signals; and opioids or cannaboids blocking different pain signals.   
     
     
         3 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 1 , further comprising the steps of:
 a. reviewing the Rehabilitation Neurophysiologic Assessment and supplemental psychological testing results and determining the precise type of physical rehabilitation needs of the patient including modalities of hot/cold, ultrasound, electric muscle stimulation; neuromuscular re-education; therapeutic exercises improving range of motion and muscle tone of a given body region; kinetic exercises which improve joint movement or extremity motion; muscle relaxants reducing, muscle tensions; and alternatives including chiropractic, massage, manual manipulation, and osteopathy; provided to the patient.   
     
     
         4 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 1 , further comprising the step of:
 a. reviewing the Rehabilitation Neurophysiologic Assessment and psychological testing results determining the precise types of mental health services required to meet individual patent's needs, with options including Cognitive Behavioral Therapy which changes the patients perceptions of relevant ideas or behavior interfering with rehabilitation; mindfulness improving general relaxation by staying in a calm moment and reducing distractions, especially distractions of a negative or emotional kind; progressive relaxation techniques localizing general muscle tightness; logotherapy treating deeper psychological problems in a search for personal life meaning; trauma therapy alleviating post-traumatic stress disorder; treating childhood adverse experiences; alternative therapies including biofeedback, neurofeedback; and deep meditation.   
     
     
         5 . The scientific method of determining the accurate individualized rehabilitation needs for appropriate patients undergoing a multidimensional rehabilitation program for patients experiencing chronic musculoskeletal or neuropathic pains of  claim 1 , the method comprising the step of:
 determining the individual's unique rehabilitation profile from the more than 200 distinct kinds of neurophysiologic and psychological responses evoked during a multidimensional program and its therapies.   
     
     
         6 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 1 , further comprising the steps of:
 a. reviewing the Rehabilitation Neurophysiologic Assessment and supplemental psychological testing results performed on patients with neuropathic conditions and determining whether the patient is a candidate for a multidimensional pain rehabilitation program;   b. determining that a patient is not a multidimensional rehabilitation program candidate, and providing the patient with long term pain management;   c. determining that a patient is a candidate for a multidimensional rehabilitation program; providing the patient with a scientifically and physiologically-determined medicinal/psychological/rehabilitative testing specifically tailored to meet that individual's specific and personal needs from over 200 hundred possible outcomes.   
     
     
         7 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 1 , further comprising the steps of:
 a, obtaining data for a patient with chronic lumbar strain from several strategically placed EMG electrodes continuously recording physiological muscle contraction before, during, and after rehabilitation efforts under two or more different conditions relevant to rehabilitative programs based upon pain initial detection and pain tolerance in one or more planes or directions of movement;   b. obtaining data for a patient with chronic lumbar strain from electrodes recording Blood Volume Pulse monitors continuously recording blood vessel tonality before, during, and after rehabilitation efforts under two or more different conditions relevant to rehabilitative programs directed to pain initial detection and pain tolerance in one or more planes or directions of movement;   c. obtaining data for a patient suffering from chronic lumbar strain, the data is obtained from electrodes recording Skin Conductance Response from monitors continuously recording body sudomotor tonality before, during, and after rehabilitation effort; under two or more different conditions relevant to rehabilitative programs with respect to pain initial detection and pain tolerance in one or more planes or directional movement;   d. obtaining data for a patient with chronic lumbar strain; the data being obtained from electrodes recording instantaneous heart rate monitors continuously recording cardiovascular autononic tonality before, during, and after rehabilitation efforts obtained under at least two or more different conditions relevant to rehabilitative programs based upon pain initial detection and pain tolerance in one or more planes or directions of movement;   e. obtaining all the above data from a patient with chronic pain using different modes of stimulation relevant to pain rehabilitation; including range of movement measures using inclinometry; different rates of movement with time measured inclinometry; tissue tenderness to physical stimulation using algometry; and neuropathic tenderness using direct current stimulation.   
     
     
         8 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 7 , further comprising the step of:
 a. providing electrode connections to the patient which obtains data relating to one or more of SCR, BVP & HR, inclinometry, GEN sEMG, and SPEC sEMG.   
     
     
         9 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 8 , further comprising the steps of:
 a. receiving the analog data and converting the analog data to digital data using both a pre-amplifier and a analog-to-digital converter.   
     
     
         10 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 9 , further comprising the step of:
 a. using the obtained digital data as part of obtaining computer computation according to protocol types and epochs, and outputting both of tabular data analysis and graphic analysis.   
     
     
         11 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 10 , further comprising the step of:
 a. using baseline stimulation and response data which graphically displays results of odynic identification threshold stimulation, SEMG responses, SCR responses, BVP responses, HR response from rest periods, and a stimulation period and a recovery period.   
     
     
         12 . The method of evaluating rehabilitation potential in patients experiencing painful or neuropathic conditions or both, of  claim 11 , further comprising the steps of:
 a. using test level stimulation and response data which graphically displays results of pain tolerance stimulation; SEMG responses, the SCR response, the BVP response, and HR response from rest periods, the stimulation period and the recovery period.   
     
     
         13 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 10 , further comprising the steps of:
 a. comparing the graphic data and tabulated data between baseline control and test level stimulations from odynic identification threshold stimulations, in determining the core type of individual baseline pain experience, of which there are many types; primary profiles include:
 a. predominant sensor physical profile; 
 b. predominant emotional profile for which there are three types;
 i. predominant anticipatory emotional profile; 
 ii. predominant reactive emotional profile; 
 iii. predominant mixed emotional profile; 
 
 c. predominant sociodynamic profile: with different combinations of these primary types; there are 15 variations or subtypes for the odynic identification threshold stimulation protocol. 
   
     
     
         14 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 10 , further comprising the step of:
 using control site stimulation and response data to graphically display results of patient odynic tolerance level stimulation, sEMG responses, the SCR response, the BVP response, and HR response from rest periods, the stimulation period and the recovery period.   
     
     
         15 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 10 , further comprising the steps of:
 [a] using Test Site stimulation and response data to graphically display results of odynic tolerance level stimulation, SEMG responses, the SCR response, the BVP response, and HR response from rest periods, the stimulation period and the patient recovery period.   
     
     
         16 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 13 , further comprising the steps of:
 [a] comparing the graphic data, and tabulated data, between paired and test sites from the odynic tolerance level stimulations, determining the secondary-type of individual baseline pain experience of which there are many types; major secondary profiles include:   a. predominant sensory-physical profile;   b. predominant emotional profile for which there are three types;
 i. predominant anticipatory emotional profile; 
 ii. predominant reactive emotional profile; 
 iii. predominant mixed emotional profile; and 
   c. predominant sociodynamic profile; with different combinations of these primary types, there are 15 variations or subtypes for the odynic tolerance level stimulation protocol.   
     
     
         17 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 13 , further comprising the step of:
 [a] comparing the results from the odynic identification threshold paired protocol with the results from the odynic tolerance level paired protocol; determining how the patient adjusts to different intensities of the pain experience, of which there are over 200 different possible combinations.   
     
     
         18 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 10 , further comprising the steps of:
 [a] using different stimulation modalities to evoke odynic identification threshold and odynic tolerance threshold, depending on rehabilitation needs, of which there are three basic types:   a. range of motion,
 i. active range of motion, the most commonly used; 
 ii. passive range of motion; 
   b. algometry, and   c. electric current stimulation.   
     
     
         19 . The method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, of  claim 17 , further comprising the step of:
 [a.] comparing the outcome of the odynic identification threshold to odynic tolerance level comparison with psychometric data; finding the best personalized rehabilitation program for the patient.   
     
     
         20 . A scientific-measurable Neurophysiological Method of evaluating rehabilitation potential in patients experiencing painful musculoskeletal or neuropathic conditions or both, thereby maximizing multidimensional protocols for rehabilitation and pain resolution: by better identifying the specific needs of each particular patient; understanding the many obstacles to rehabilitation which fall into motivational, physical, and emotional categories; physical obstacles to rehabilitation including but not limited to incorrect diagnoses, refractory pain, and deconditioning; emotional obstacles to rehabilitation including fear avoidance, catastrophizing, generalized anxiety, depression, childhood adverse events, emotional awareness deficits; and motivational obstacles to rehabilitation including factitious disorder, personality disorders, malingering and apathy; the method comprising the steps of:
 a. determining whether a referred patient has completed or not completed a traditional biomedical evaluation of chronic musculoskeletal or neuropathic pain symptoms;   b. completing the traditional biomedical evaluation after determining that the evaluation was not complete;   c. finding a previously unidentified biomedical problem; patient referred to the appropriate specialist for definitive traditional care;   d. finding that the patient is not a good candidate for traditional biomedical care, the patient is referred for an initial Biopsychosocial Pain Model rehabilitation evaluation;   e. performing the initial Biopsychosocial Pain Model rehabilitation evaluation and finding that the patient is not good rehabilitation candidate, patient referred to chronic palliative pain management;   f. the Biopsychosocial Pain Model Evaluation leads to one or two outcomes; performing the initial Biopsychosocial Pain Model rehabilitation evaluation and finding that the patient is a good rehabilitation candidate, patient obtains a more detailed evaluation which accurately determines that the patient's multidimensional rehabilitation requirements;   g. performing a scientific, neurophysiologically-based Rehabilitation Neurophysiologic Assessment supplemented by a psychological evaluation, the results are reviewed by the multidimensional rehabilitation team leader;   h. reviewing the results of the Rehabilitation Neurophysiologic Assessment supplemented by the psychological evaluation, the patient determined to not be a rehabilitation candidate; and patient referred for chronic palliative pain management;   i. reviewing the results of the Rehabilitation Neurophysiologic Assessment supplemented by a psychological evaluation, the patient determined to be a good rehabilitation candidate and referred for multidimensional rehabilitation with accurate specific details to meet that patient's needs.   
     
     
         21 . A method of evaluation rehabilitation potential in patients experiencing musculoskeletal painful musculoskeletal or neuropathic conditions or both, to maximize outcomes from multidimensional pain rehabilitation and resolution protocols by better identifying each particular person's needs in three necessary areas relevant to rehabilitation success while identifying potential impediments, biophysical problems including incorrect diagnoses, refractory physical pain, deconditioning; emotional obstacles to rehabilitation including fear avoidance, generalized anxiety, depression, childhood events, and emotional awareness difficulties; and negative motivational obstacles to rehabilitation including factitious disorder, personality disorders, psychotic psychiatric diagnoses, malingering, apathy; and sociodynamic factors that cannot contribute to treatment failure if unidentified; the method comprising the steps of:
 a. determining whether the referred patient's prior traditional biomedical evaluation was complete or incomplete;   b; finding the prior traditional biomedical work-up incomplete, completing the work-up; a patient with previously unidentified biomedical problems referred for definitive for definitive traditional biomedical care;   c. finding the prior traditional biomedical work-up incomplete, the work-up is completed; a patient with no unidentified issues is referred to an initial Biopsychosocial Pain Model evaluation; biophysical, emotional, and motivational/sociodynamic factors are assessed;   d. performing the initial Biopsychosocial Pain Model evaluation and determining that the patient is not a good candidate for a multidimensional Biopsychosocial pain rehabilitation program, patient referred for chronic palliative pain management;   e. performing the initial Biopsychosocial Pain Model evaluation and determining that the patient is a good candidate for a multidimensional Biopsychosocial Pain rehabilitation program, patient referred for a detailed neuroscientifically valid Rehabilitation Neurophysiologic Assessment supplemented by psychological assessment;   f. performing the neuroscientifically valid Rehabilitation Neurophysiologic Assessment and supplemental psychological testing, patient determined to not be a rehabilitation candidate is referred to chronic palliative pain management;   g. performing the neuroscientifically valid Rehabilitation Neurophysiologic Assessment and supplemental psychological testing, the patient e determined to be a good rehabilitation candidate and is referred to a multidimensional pain rehabilitation with the test used to design and implement an individualized multidimensional program according to the tenets of precision medicine to maximize a successful outcome; treatment needs of specifically identified biophysical, emotional, and sociodynamic problems are managed.   
     
     
         22 . A method for the evaluating the patient potential rehabilitation of a patient suffering from neuropathic or musculoskeletal or combined conditions; scientifically identifying a patient's specific pain rehabilitation needs according to the Biopsychosocial Model of Pain; the testing provides unprecedented data concerning the biophysical, emotional, and sociodynamic factors combining to create chronic pain; using that information to design and implement an individualized multidimensional rehabilitation to maximize a successful outcome; the method compromising the steps of:
 a. determining whether the referred patient's prior traditional biomedical work-up was complete or incomplete;   b. finding the prior traditional work-up incomplete, the work-up is completed; and finding any previously unidentified biomedical conditions, referral for definitive traditional biomedical treatment is made;   c. finding the prior traditional work-up complete, the patient is initially assessed for multidimensional rehabilitation according to the Biopsychosocial Model of Pain, and determined to not be a good rehabilitation candidate; the patient is referred for chronic palliative pain management;   d. finding the prior traditional work-up complete, the patient is initially assessed for multidimensional rehabilitation according to the Biopsychosocial Model of Pain, and determined to be a good rehabilitation candidate; the patient e, undergoes the scientifically valid Rehabilitation Physiologic Assessment and psychometric testing;   f. performing the Rehabilitation Neurophysiologic Assessment supplemented by psychological evaluation and reviewing the data, the person will be determined not to be a good candidate for multidimensional rehabilitation program and is referred for chronic palliative pain management;   g. performing the Rehabilitation Neurophysiologic Assessment supplemented by psychological evaluation and reviewing the data; the patient is determined to be a good candidate for multidimensional pain rehabilitation, the data from above assessments are used to create and implement a patient-specific, individualized rehabilitation program.   
     
     
         23 . A method for the evaluating the patient potential rehabilitation of a patient suffering from neuropathic or musculoskeletal or combined conditions the method compromising the steps of:
 a. determining whether the referred patients prior traditional biomedical work-up was complete or incomplete   b. finding the prior traditional work-up incomplete, the work-up is completed; and finding any previously unidentified biomedical conditions, referral for definitive traditional biomedical treatment is made;   c. finding the prior traditional work-up complete, the patient is initially assessed for multidimensional rehabilitation according to the Biopsychosocial Model of Pain, and determined to not be a good rehabilitation candidate; the patient is referred for chronic palliative pain management;   d. finding the prior traditional work-up complete, the patient is initially assessed for multidimensional rehabilitation according to the Biopsychosocial Model of Pain,   e. determining the patient to be a good rehabilitation candidate; the patient undergoes the scientifically valid Rehabilitation Physiologic Assessment and psychometric testing;   f. performing the Rehabilitation Neurophysiologic Assessment supplemented by psychological evaluation and reviewing the date, the person is determined not to be a good candidate for multidimensional rehabilitation program and is referred for chronic palliative pain management;   g. performing the Rehabilitation Physiologic Assessment supplemented by psychological evaluation and reviewing the data; the patient is determined to be a good candidate for multidimensional pain rehabilitation, the data from above assessments is used to create and implement a patient-specific, individualized rehabilitation program;